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Graupner O, Rath C, Lecker L, Ritter M, Ritgen J, Enzensberger C. Role of Ductus Venosus Doppler Sonography for the Prediction of Perinatal Outcome in Term Pregnancies Complicated by Gestational Diabetes Mellitus. Z Geburtshilfe Neonatol 2024; 228:363-369. [PMID: 38519041 DOI: 10.1055/a-2272-6743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
PURPOSE Ductus venosus (DV) Doppler velocimetry reflects fetal cardiac function. Gestational diabetes mellitus (GDM) is assumed to impair cardiac function due to fetal hyperglycemia. The purpose of this study was to assess the ability of DV Doppler to predict an adverse perinatal outcome (APO) in term pregnancies with GDM. METHODS This is a retrospective cohort study including GDM pregnancies of singleton, non-anomalous fetuses without any signs of placental dysfunction. All GDM women who primarily had a vaginal delivery attempt and in which DV Doppler was examined from 37+0 weeks on were included. Receiver operating characteristic curve (ROC) analyses were performed to assess the predictive value of DV pulsatility index (DV-PI) regarding a composite APO (CAPO). Furthermore, a subgroup analysis was performed regarding the presence of a large-for-gestational-age (LGA) newborn. RESULTS A total of n=89 cases were included. Overall, CAPO occurred in 26 out of 89 cases (29.2%). All DV Doppler examinations showed a positive A wave. DV-PI was>95th percentile in 8 out of 89 cases (9%). Overall, ROC analysis showed no significant association of DV-PI with CAPO (AUC=0.523, p=0.735). However, regarding individual APO parameters, ROC analysis showed a significant association of DV-PI with 5th-min AGPAR (AUC=0.960, p=0.027), which was not confirmed after exclusion of LGA cases. CONCLUSION In GDM pregnancies at term, DV Doppler sonography seems to have no benefit for APO prediction.
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Affiliation(s)
- Oliver Graupner
- Department of Obstetrics and Gynecology, University Hospital Aachen, Aachen, Germany
- Department of Obstetrics and Gynecology, Technical University of Munich Hospital Rechts der Isar, München, Germany
| | - Caroline Rath
- Department of Obstetrics and Gynecology, University Hospital Aachen, Aachen, Germany
| | - Linda Lecker
- Department of Obstetrics and Gynecology, University Hospital Aachen, Aachen, Germany
| | - Monica Ritter
- Department of Obstetrics and Gynecology, University Hospital Aachen, Aachen, Germany
| | - Jochen Ritgen
- Department of Obstetrics and Gynecology, University Hospital Aachen, Aachen, Germany
- Praenatal Plus, Köln, Germany
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Schiermeier S, von Kaisenberg CS, Kehl S, Reister F, Mosimann B, Reif P, Harlfinger W, König K, Schwarz C, Matern E, Kühnert M, Schmitz R, Hoopmann M, Ramsell A, Kalberer BS, Heule PG, Heinzl S, Kayer B, Gruber P, Steiner H, Schäffer L. Fetal Assessment in Pregnancy (Indication and Methodology for Fetal Monitoring in a low-risk Population). Guideline of the DGGG, DEGUM, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/089, February 2023). ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:147-167. [PMID: 37582399 DOI: 10.1055/a-2113-7638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
PURPOSE The aim of this guideline was to find evidence on whether carrying out Doppler examinations and CTGs in low-risk cohorts of pregnant women improves outcomes. METHODS First, a systematic search for guidelines was carried out. Identified guidelines were evaluated using the DELPHI instrument of the AWMF. Three guidelines were found to be suitable to evaluate CTG. Two DEGUM best practice guidelines were judged suitable to describe the methods. All studies on this issue were additionally analyzed using 8 PICO questions. A structured consensus of the participating professional societies was achieved using a nominal group process and a structured consensus conference moderated by an independent moderator. RECOMMENDATIONS No antepartum Doppler sonography examinations should be carried out in low-risk cohorts in the context of antenatal care. No antepartum CTG should be carried out in low-risk cohorts. NOTE: The guideline will be published simultaneously in the official journals of both professional societies (i. e., Geburtshilfe und Frauenheilkunde for the DGGG and Ultraschall in der Medizin/European Journal of Ultrasound for the DEGUM).
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Affiliation(s)
- Sven Schiermeier
- Lehrstuhl für Frauenheilkunde und Geburtshilfe der Universität Witten/Herdecke, Marien-Hospital Witten, Witten, Germany
| | | | - Sven Kehl
- Gynecology and Obstetrics, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Frank Reister
- Sektion Geburtshilfe, Univ.-Frauenklinik, Univ.-Klinikum Ulm, Ulm, Germany
| | - Beatrice Mosimann
- University Women's Hospital, Department of Obstetrics, Inselspital, Bern, Switzerland
| | - Philipp Reif
- Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | | | - Klaus König
- Berufsverband der Frauenärzte, Eschborn, Germany
| | - Christiane Schwarz
- Institute of Health Sciences, Department of Midwifery Science, Universität zu Lübeck, Lübeck, Germany
| | - Elke Matern
- Medical Department, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Maritta Kühnert
- Geburtshilfe, Philipps-Universität Marburg, Marburg, Germany
| | - Ralf Schmitz
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Markus Hoopmann
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | | | | | | | | | - Beate Kayer
- Österreichisches Hebammengremium, Wien, Austria
| | | | - Horst Steiner
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Landeskrankenhaus Salzburg, Paracelsus, Salzburg, Austria
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Schiermeier S, von Kaisenberg CS, Kehl S, Reister F, Mosimann B, Reif P, Harlfinger W, König K, Schwarz C, Matern E, Kühnert M, Schmitz R, Hoopmann M, Ramsell A, Kalberer BS, Heule PG, Heinzl S, Kayer B, Gruber P, Steiner H, Schaeffer L. Fetal Assessment in Pregnancy (Indication and Methodology for Fetal Monitoring in a Low-risk Population). Guideline of the DGGG, DEGUM, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/089, February 2023). Geburtshilfe Frauenheilkd 2023; 83:996-1016. [PMID: 37588256 PMCID: PMC10427199 DOI: 10.1055/a-2096-1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 08/18/2023] Open
Abstract
Purpose The aim of this guideline was to find evidence on whether carrying out Doppler examinations and CTGs in low-risk cohorts of pregnant women improves outcomes. Methods First, a systematic search for guidelines was carried out. Identified guidelines were evaluated using the DELPHI instrument of the AWMF. Three guidelines were found to be suitable to evaluate CTG. Two DEGUM best practice guidelines were judged suitable to describe the methods. All studies on this issue were additionally analyzed using 8 PICO questions. A structured consensus of the participating professional societies was achieved using a nominal group process and a structured consensus conference moderated by an independent moderator. Recommendations No antepartum Doppler sonography examinations should be carried out in low-risk cohorts in the context of antenatal care. No antepartum CTG should be carried out in low-risk cohorts. Note The guideline will be published simultaneously in the official journals of both professional societies (i.e., Geburtshilfe und Frauenheilkunde for the DGGG and Ultraschall in der Medizin/European Journal of Ultrasound for the DEGUM).
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Affiliation(s)
- Sven Schiermeier
- Lehrstuhl für Frauenheilkunde und Geburtshilfe der Universität Witten/Herdecke, Marien-Hospital Witten, Witten, Germany
| | | | - Sven Kehl
- Gynecology & Obstetrics, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Frank Reister
- Sektion Geburtshilfe, Univ.-Frauenklinik, Univ.-Klinikum Ulm, Ulm, Germany
| | - Beatrice Mosimann
- University Womenʼs Hospital, Department of Obstetrics, Inselspital, Bern, Switzerland
| | - Philipp Reif
- Obstetrics & Gynecology, Medical University of Graz, Graz, Austria
| | | | - Klaus König
- Berufsverband der Frauenärzte, Eschborn, Germany
| | - Christiane Schwarz
- Institute of Health Sciences, Department of Midwifery Science, Universität zu Lübeck, Lübeck, Germany
| | - Elke Matern
- Medical Department, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Maritta Kühnert
- Geburtshilfe, Philipps-Universität Marburg, Marburg, Germany
| | - Ralf Schmitz
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Markus Hoopmann
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | | | | | | | | | - Beate Kayer
- Österreichisches Hebammengremium, Wien, Austria
| | | | - Horst Steiner
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Landeskrankenhaus Salzburg, Paracelsus, Salzburg, Austria
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Schmand C, Misselwitz B, Hudel H, Bedei I, Wolter A, Schenk J, Keil C, Köhler S, Axt-Fliedner R. Analysis of the Results of Sonographic Screening Examinations According to the Maternity Guidelines Before and After the Introduction of the Extended Basic Screening (IIb Screening) in Hesse. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:e175-e183. [PMID: 35304733 DOI: 10.1055/a-1778-3585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM OF THE STUDY The aim of the study is to examine the detection rates of malformations before and after the introduction of extended basic screening in Hesse by the Federal Joint Committee (Gemeinsamer Bundesausschuss, GQH) on July 1, 2013. METHOD This is a retrospective, mainly exploratory data analysis of quality assurance data from the Office for Quality Assurance in Hesse (GQH). The data was collected in the period from January 1, 2010 to December 31, 2016 in the obstetric departments of the Hessian hospitals using documentation forms. The classification and evaluation of the diagnoses is based on ICD-10-GM-2019. RESULTS At least one malformation is present in 0.7% of the cases. With a share of 30.0%, most of the congenital malformations are from the musculoskeletal system. 12.2% of the malformations come from the facial cleft, closely followed by malformations of the circulatory system with 11.3%. The highest prenatal detection rate (PDR) is found in congenital malformations of the nervous system at 56.8%. The lowest PDR is found in those of the genital organs with 2.1%. The PDR of cardiovascular malformations is 32.9%. Overall, a PDR of 25.2% is achieved. There was no change in the number of prenatal malformation diagnoses after the introduction of extended basic ultrasound. The distribution of malformation diagnoses not detected prenatally to the organ systems also has not changed after the introduction. CONCLUSION The introduction of extended basic ultrasound did not bring the desired improvement with regard to the PDR in Hesse. Alternative approaches should be considered.
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Affiliation(s)
- Christine Schmand
- Division of Prenatal Medicine, Departement of Obstetrics and Gynecology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Björn Misselwitz
- Head of the office and project management, Office for Quality Assurance in Hesse, Eschborn, Germany
| | - Helge Hudel
- Department of Medical Statistics, Justus-Liebig-University, Giessen, Germany
| | - Ivonne Bedei
- Division of Prenatal Medicine, Departement of Obstetrics and Gynecology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Aline Wolter
- Division of Prenatal Medicine, Departement of Obstetrics and Gynecology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Johanna Schenk
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Corinna Keil
- Prenatal Medicine and Fetal Therapy, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Siegmund Köhler
- Prenatal Medicine and Fetal Therapy, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Roland Axt-Fliedner
- Division of Prenatal Medicine, Departement of Obstetrics and Gynecology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
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Pecks U, Agel L, Doubek KJ, Hagenbeck C, Jennewein L, von Kaisenberg C, Kranke P, Leitner S, Mand N, Rüdiger M, Zöllkau J, Mingers N, Sitter M, Louwen F. SARS-CoV-2 in Pregnancy, Birth and Puerperium. Guideline of the DGGG and DGPM (S2k-Level, AWMF Registry Number 015/092, March 2022). Geburtshilfe Frauenheilkd 2023; 83:517-546. [PMID: 39258218 PMCID: PMC11384259 DOI: 10.1055/a-2003-5983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 03/11/2023] Open
Abstract
Objective This S2k guideline of the German Society for Gynecology and Obstetrics (DGGG) and the German Society of Perinatal Medicine (DGPM) contains consensus-based recommendations for the care and treatment of pregnant women, parturient women, women who have recently given birth, and breastfeeding women with SARS-CoV-2 infection and their newborn infants. The aim of the guideline is to provide recommendations for action in the time of the COVID-19 pandemic for professionals caring for the above-listed groups of people. Methods The PICO format was used to develop specific questions. A systematic targeted search of the literature was carried out using PubMed, and previously formulated statements and recommendations issued by the DGGG and the DGPM were used to summarize the evidence. This guideline also drew on research data from the CRONOS registry. As the data basis was insufficient for a purely evidence-based guideline, the guideline was compiled using an S2k-level consensus-based process. After summarizing and presenting the available data, the guideline authors drafted recommendations in response to the formulated PICO questions, which were then discussed and voted on. Recommendations Recommendations on hygiene measures, prevention measures and care during pregnancy, delivery, the puerperium and while breastfeeding were prepared. They also included aspects relating to the monitoring of mother and child during and after infection with COVID-19, indications for thrombosis prophylaxis, caring for women with COVID-19 while they are giving birth, the presence of birth companions, postnatal care, and testing and monitoring the neonate during rooming-in or on the pediatric ward.
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Affiliation(s)
- Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Lena Agel
- Technische Hochschule Aschaffenburg, Hebammenkunde, Aschaffenburg, Germany
| | | | - Carsten Hagenbeck
- Geburtshilfe und Perinatalmedizin, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Lukas Jennewein
- Geburtshilfe und Pränatalmedizin, Universitätsklinikum Frankfurt Goethe-Universität, Frankfurt am Main, Germany
| | - Constantin von Kaisenberg
- Pränatalmedizin und Geburtshilfe im Perinatalzentrum, Universitätsklinik der Medizinischen Hochschule Hannover, Hannover, Germany
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Sabine Leitner
- Bundesverband "Das frühgeborene Kind" e. V., Frankfurt, Germany
| | - Nadine Mand
- Philipps-Universität Marburg, Zentrum für Kinder- und Jugendmedizin, Marburg, Germany
| | - Mario Rüdiger
- Klinik für Kinder- und Jugendmedizin, Fachbereich Neonatologie und pädiatrische Intensivmedizin, Medizinische Fakultät der TU Dresden, Dresden, Germany
| | - Janine Zöllkau
- Klinik für Geburtsmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Nina Mingers
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Magdalena Sitter
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Frank Louwen
- Geburtshilfe und Pränatalmedizin, Universitätsklinikum Frankfurt Goethe-Universität, Frankfurt am Main, Germany
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de Sainte Fare A, Bedei I, Wolter A, Schenk J, Widriani E, Keil C, Koehler S, Bahlmann F, Strizek B, Gembruch U, Berg C, Axt-Fliedner R. The Value of Delta Middle Cerebral Artery Peak Systolic Velocity for the Prediction of Twin Anemia-Polycythemia Sequence-Analysis of a Heterogenous Cohort of Monochorionic Twins. J Clin Med 2022; 11:jcm11247541. [PMID: 36556157 PMCID: PMC9783345 DOI: 10.3390/jcm11247541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction: Twin anemia-polycythemia sequence (TAPS) is a complication in monochorionic-diamniotic (MCDA) twin pregnancies. This study analyzes whether the prenatal diagnosis using delta middle cerebral artery-peak systolic velocity (MCA-PSV) > 0.5 multiples of the median (MoM) (delta group) detects more TAPS cases than the guideline-based diagnosis using the MCA-PSV cut off levels of >1.5 and <1.0 MoM (cut-off group), in a heterogenous group of MCDA twins. Methods: A retrospective analysis of 348 live-born MCDA twin pregnancies from 2010 to 2021 with available information on MCA-PSV within one week before delivery and hemoglobin-values within 24 h postnatally were considered eligible. Results: Among postnatal confirmed twin pairs with TAPS, the cut-off group showed lower sensitivity than the delta group (33% vs. 82%). Specificity proved higher in the cut-off group with 97% than in the delta group at 86%. The risk that a TAPS is mistakenly not recognized prenatally is higher in the cut-off group than in the delta group (52% vs. 18%). Conclusions: Our data shows that delta MCA-PSV > 0.5 MoM detects more cases of TAPS, which would not have been diagnosed prenatally according to the current guidelines. In the collective examined in the present study, TAPS diagnostics using delta MCA-PSV proved to be a more robust method.
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Affiliation(s)
- Anthea de Sainte Fare
- Department of Prenatal Medicine and Fetal Therapy, University Hospital Giessen, 35392 Giessen, Germany
- Correspondence: ; Tel.: +49-17-68458-5617
| | - Ivonne Bedei
- Department of Prenatal Medicine and Fetal Therapy, University Hospital Giessen, 35392 Giessen, Germany
| | - Aline Wolter
- Department of Prenatal Medicine and Fetal Therapy, University Hospital Giessen, 35392 Giessen, Germany
| | - Johanna Schenk
- Department of Prenatal Medicine and Fetal Therapy, University Hospital Giessen, 35392 Giessen, Germany
| | - Ellydda Widriani
- Department of Prenatal Medicine and Fetal Therapy, University Hospital Giessen, 35392 Giessen, Germany
| | - Corinna Keil
- Department of Prenatal Medicine and Fetal Therapy, University Hospital Marburg, 35041 Marburg, Germany
| | - Siegmund Koehler
- Department of Prenatal Medicine and Fetal Therapy, University Hospital Marburg, 35041 Marburg, Germany
| | - Franz Bahlmann
- Department of Ultrasound Diagnostics and Prenatal Medicine, Buergerhospital Frankfurt, 60318 Frankfurt, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, 53127 Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, 53127 Bonn, Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, 53127 Bonn, Germany
- Department of Prenatal Medicine and Gynaecological Ultrasound, University Hospital Cologne, 50937 Cologne, Germany
| | - Roland Axt-Fliedner
- Department of Prenatal Medicine and Fetal Therapy, University Hospital Giessen, 35392 Giessen, Germany
- Department of Prenatal Medicine and Fetal Therapy, University Hospital Marburg, 35041 Marburg, Germany
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Graupner O, Meister M, Lecker L, Karim-Payab S, Franz C, Carow J, Enzensberger C. Role of the cerebro-placental-uterine ratio in predicting adverse perinatal outcome in low-risk pregnancies at term. Arch Gynecol Obstet 2022:10.1007/s00404-022-06733-8. [PMID: 36038657 DOI: 10.1007/s00404-022-06733-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The cerebroplacental ratio (CPR) is associated with adverse perinatal outcome (APO) in low-risk pregnancies near term. A Doppler parameter, which also includes information from the uterine vessels could potentially improve detection of subclinical placental dysfunction. The aim of this study is to investigate the performance of cerebro-placental-uterine ratio (CPUR) related to APO prediction in low-risk term pregnancies in > 40 + 0 weeks. METHODS This is a retrospective cohort study. All low-risk pregnancies in which feto-maternal Doppler was examined from 40 + 0 weeks and an appropriate for gestational age fetus was present were included. ROC (receiver operating characteristic curves) analyses were performed to assess the predictive value of CPUR. The presence of at least one of the following outcome parameters was defined as composite APO (CAPO): operative delivery (OD) due to intrapartum fetal compromise (IFC), admission to the neonatal intensive care unit, umbilical cord arterial pH ≤ 7.15, 5 min APGAR ≤ 7. RESULTS A total of n = 114 cases were included. Mean gestational age at examination and delivery were 40 + 3 weeks and 40 + 6 weeks, respectively. Overall, CAPO occurred in 38 of 114 cases (33.3%). ROC analyses showed a significant association of CPUR (AUC = 0.67, p = 0.004) and CPR (AUC = 0.68, p = 0.002) with CAPO. Additionally, CPUR (AUC = 0.64, p = 0.040) showed a predictive value for OD due to IFC. CONCLUSION The CPUR in > 40 + 0 weeks showed a predictive value for CAPO and OD due to IFC in low-risk pregnancies. However, the extent to which CPUR can be used to optimize delivery management warrants further investigations in prospective interventional studies.
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Affiliation(s)
- Oliver Graupner
- Department of Obstetrics and Gynecology, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße, 30 52074, Aachen, Germany. .,Department of Obstetrics and Gynecology, University Hospital Rechts Der Isar, Technical University, Munich, Germany.
| | - Markus Meister
- Department of Obstetrics and Gynecology, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße, 30 52074, Aachen, Germany
| | - Linda Lecker
- Department of Obstetrics and Gynecology, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße, 30 52074, Aachen, Germany
| | - Sepideh Karim-Payab
- Department of Obstetrics and Gynecology, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße, 30 52074, Aachen, Germany
| | - Cordula Franz
- Department of Obstetrics and Gynecology, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße, 30 52074, Aachen, Germany
| | - Juliane Carow
- Department of Obstetrics and Gynecology, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße, 30 52074, Aachen, Germany
| | - Christian Enzensberger
- Department of Obstetrics and Gynecology, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße, 30 52074, Aachen, Germany
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Grüttner B, Ratiu J, Ratiu D, Gottschalk I, Morgenstern B, Abel JS, Eichler C, Pahmeyer C, Ludwig S, Mallmann P, Thangarajah F. Correlation of Cerebroplacental Ratio (CPR) With Adverse Perinatal Outcome in Singleton Pregnancies. In Vivo 2020; 33:1703-1706. [PMID: 31471427 DOI: 10.21873/invivo.11659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/01/2019] [Accepted: 07/10/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND/AIM For many years clinical research has been concerned with doppler sonography as a non-invasive tool for intrauterine fetal status assessment. A new focus is now placed on the measurement of cerebroplacental index (CPR) as a predictor of fetal outcome. Our aim was to investigate the relationship between the cerebroplacental ratio (CPR), the delivery mode and the fetal outcome in singleton pregnancies. PATIENTS AND METHODS A retrospective cohort study of pregnancies in which doppler sonography of middle cerebral artery (MCA) and umbilical artery (UA) was conducted up to 9 weeks before delivery took place. Patients with pathological (CPR≤1.0) and normal CPR (>1.0) were compared by umbilical cord pH, APGAR scores, birth weight, delivery week and delivery mode. RESULTS A total of 2,270 singleton pregnancies were included. The APGAR score for 1, 5 and 10 minutes and the gestational age at delivery were significantly lower in the group of patients with pathological CPR (p<0.001). Overall, 50% of the cohort had a cesarean section, the difference between the groups was statistically significant (p<0.001), with a higher amount of cesareans in the group of patients with pathological CPR. The multiple regression analysis showed a significantly improved pH of delivery when cesarean section (p<0.001), female sex of fetus (p=0.013) and higher CPR (p=0.035) were present. CONCLUSION The measurement of CPR is an important, non-invasive predictive parameter and leads to the identification of a risk collective even in the non-selected patient population and thus probably to a reduction of perinatal morbidity.
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Affiliation(s)
- Berthold Grüttner
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Jessika Ratiu
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Dominik Ratiu
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Ingo Gottschalk
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Bernd Morgenstern
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Judith Sarah Abel
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Christian Eichler
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Caroline Pahmeyer
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Sebastian Ludwig
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Fabinshy Thangarajah
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
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